The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement

J Bone Joint Surg Br. 2011 Jan;93(1):96-101. doi: 10.1302/0301-620X.93B1.25087.


Peri-prosthetic fracture after joint replacement in the lower limb is associated with significant morbidity. The primary aim of this study was to investigate the incidence of peri-prosthetic fracture after total hip replacement (THR) and total knee replacement (TKR) over a ten-year period using a population-based linked dataset. Between 1 April 1997 and 31 March 2008, 52,136 primary THRs, 8726 revision THRs, 44,511 primary TKRs, and 3222 revision TKRs were performed. Five years post-operatively, the rate of fracture was 0.9% after primary THR, 4.2% after revision THR, 0.6% after primary TKR and 1.7% after revision TKR. Comparison of survival analysis for all primary and revision arthroplasties showed peri-prosthetic fractures were more likely in females, patients aged > 70 and after revision arthroplasty. Female patients aged > 70 should be warned of a significantly increased risk of peri-prosthetic fracture after hip or knee replacement. The use of adjuvant medical treatment to reduce the effect of peri-prosthetic osteoporosis may be a direction of research for these patients.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Arthroplasty, Replacement, Hip / statistics & numerical data
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Arthroplasty, Replacement, Knee / statistics & numerical data
  • Epidemiologic Methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoporotic Fractures / epidemiology
  • Osteoporotic Fractures / etiology
  • Periprosthetic Fractures / epidemiology
  • Periprosthetic Fractures / etiology*
  • Reoperation / adverse effects
  • Reoperation / statistics & numerical data
  • Scotland / epidemiology
  • Sex Factors
  • Young Adult